Early Durata Lead Failure Caused by Rib-Clavicular Crush

The patented Optim coating was designed to prevent insulation abrasions on the Durata lead (St Jude Medical, St Paul, Minnesota) and avoid the problems that had afflicted its predecessor, the Riata silicone lead (St Jude Medical). We report a case of external insulation failure 8 months after implantation of a dual-coil Durata lead and consider the potential causes of the failure.     

Thymosin alpha 1: A comprehensive review of the literature

Thymosin alpha 1 is a peptide naturally occurring in the thymus that has long been recognized for modifying, enhancing, and restoring immune function. Thymosin alpha 1 has been utilized in the treatment of immunocompromised states and malignancies, as an enhancer of vaccine response, and as a means of curbing morbidity and mortality in sepsis and numerous infections. Studies have postulated that thymosin alpha 1 could help improve the outcome in severely ill corona virus disease 2019 patients by repairing damage caused by overactivation of lymphocytic immunity and how thymosin alpha 1 could prevent the excessive activation of T cells. In this review, we discuss key literature on the background knowledge and current clinical uses of thymosin alpha 1. Considering the known biochemical properties including antibacterial and antiviral properties, time-honored applications, and the new promising findings regarding the use of thymosin, we believe that thymosin alpha 1 deserves further investigation into its antiviral properties and possible repurposing as a treatment against severe acute respiratory syndrome coronavirus-2.     

Systemic Therapy and Its Surgical Implications in Patients with Resectable Liver Colorectal Cancer Metastases. A Report from the Western Canadian Gastrointestinal Cancer Consensus Conference

The Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) convened virtually on 4 November 2021. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals, including surgical, medical, and radiation oncologists; pathologists; radiologists; and allied health care professionals from across four Western Canadian provinces, British Columbia, Alberta, Saskatchewan, and Manitoba, who are involved in the care of patients with gastrointestinal cancer. They participated in presentation and discussion sessions for the purpose of developing recommendations on the role of systemic therapy and its optimal sequence in patients with resectable metastatic colorectal cancer.     

First imaging results of an intraindividual comparison of 11C-acetate and 18F-fluorocholine PET/CT in patients with prostate cancer at early biochemical first or second relapse after prostatectomy or radiotherapy

Purpose

¹⁸F-Fluorocholine (FCH) and ¹¹C-acetate (ACE) PET are widely used for detection of recurrent prostate cancer (PC). We present the first results of a comparative, prospective PET/CT study of both tracers evaluated in the same patients presenting with recurrence and low PSA to compare the diagnostic information provided by the two tracers.

Methods

The study group comprised 23 patients studied for a rising PSA level after radical prostatectomy (RP, 7 patients, PSA ≤3 ng/ml), curative radiotherapy (RT, 7 patients, PSA ≤5 ng/ml) or RP and salvage RT (9 patients, PSA ≤5 ng/ml). Both FCH and ACE PET/CT scans were performed in a random sequence a median of 4 days (range 0 to 11 days) apart. FCH PET/CT was started at injection (307?±?16 MBq) with a 10-min dynamic acquisition of the prostate bed, followed by a whole-body PET scan and late (45 min) imaging of the pelvis. ACE PET/CT was performed as a double whole-body PET scan starting 5 and 22 min after injection (994?±?72 MBq), and a late view (45 min) of the prostate bed. PET/CT scans were blindly reviewed by two independent pairs of two experienced nuclear medicine physicians, discordant subgroup results being discussed to reach a consensus for positive, negative end equivocal results.

Results

PET results were concordant in 88 out of 92 local, regional and distant findings (Cohen’s kappa 0.929). In particular, results were concordant in all patients concerning local status, bone metastases and distant findings. Lymph-node results were concordant in 19 patients and different in 4 patients. On a per-patient basis results were concordant in 22 of 23 patients (14 positive, 5 negative and 3 equivocal). In only one patient was ACE PET/CT positive for nodal metastases while FCH PET/CT was overall negative; interestingly, the ACE-positive and FCH-negative lymph nodes became positive in a second FCH PET/CT scan performed a few months later.

Conclusion

Overall, ACE and FCH PET/CT showed excellent concordance, on both a per-lesion and a per-patient basis, suggesting that both tracers perform equally for recurrent prostate cancer staging.     

Thyroid-stimulating hormone, thyroid hormones, and bone loss

It has become accepted by virtue of rich anecdotal experience and clinical research that thyrotoxicosis is associated with high-turnover osteoporosis. The bone loss, primarily due to accelerated resorption that is not compensated by a coupled increase in bone formation, has been attributed solely to elevated thyroid hormone levels. Evidence using mice lacking the thyroid hormone receptors α and β establishes a role for thyroid hormones in regulating bone remodeling but does not exclude an independent action of thyroid-stimulating hormone (TSH), levels of which are low in hyperthyroid states, even when thyroid hormones are normal, as after thyroxine supplementation and in subclinical hyperthyroidism. We show that TSH directly suppresses bone remodeling and that TSH receptor null mice have profound bone loss, suggesting that reduced TSH signaling contributes to hyperthyroid osteoporosis. TSH and its receptor could become valuable drug targets in treating bone loss.     

Echocardiographic Assessment of Atrial Properties in Single Ventricles vs. Normal Controls

Introduction. Atrial function is increasingly being recognized as a significant factor in overall cardiac function in adults. Limited studies evaluating atrial properties exist in the pediatric congenital heart disease population. The goal of this study was to evaluate atrial properties in patients with single ventricle physiology after Fontan completion and compare these values with normal control patients. Methods. Echocardiograms were performed in patients with single ventricular physiology and in control patients. Tissue Doppler and blood flow measurements were obtained. Atrial fraction and atrial electromechanical values were calculated. Differences were assessed with one‐way analysis of variance. Post hoc comparisons were performed with Tukey adjustment. P < .05 was considered significant. Results. No significant difference was present in age or heart rate between single ventricle and control patients. The single right ventricle tricuspid valve A wave (52.6 ± 14.5 vs. 36.7 ± 10.4 cm/s) and atrial fraction (39.2 ± 6.2 vs. 32.7 ± 7.7%) were significantly higher, and the E/A ratio (1.4 + 0.3 vs. 1.8 + 0.4), tricuspid valve E/A velocity–time integral (1.6 + 0.4 vs. 2.2 + 0.7 cm), and late diastolic annular value (5.3 + 1.5 vs. 8.7 + 1.4 cm/s) were significantly lower compared with the controls. The single left ventricle late diastolic annular velocity (4.2 + 1.0 vs. 6.7 + 1.3 cm/s) was significantly lower and atrial fraction was significantly higher compared with the controls (37.7 ± 12.5 vs. 29.8 ± 4.3%). There were no significant differences in atrial electromechanical measurements between groups, but the single right ventricle patients tended to have increased atrial dyssynchrony compared with controls. Conclusions. Patients with single ventricle physiology after Fontan completion have differences in atrial properties when compared with normal controls. These differences may have important implications in their long‐term outcomes. Further studies are necessary to determine the clinical significance of these findings.     

Sexual rights and gender roles in a religious context

A common feature of the five faiths discussed in this article is change over time. This allowed diversity within the religions, and generally led to a degree of liberalization, but in some faiths or their sects, resulted in a narrow or rigid interpretation. For example, the golden Vedic Period of Hinduism in India when “women were worshipped” gradually faded, ushering in the social evils of female feticide, child marriage, and “sati.” The advent of Islam in the seventh century banned female infanticide, but has been unable to abolish many tribal pre-Islamic customs such as female genital mutilation in Africa and “honor killings” in parts of Asia. On the other hand, in China, the inferior status of women accorded by Confucianism has been rectified to a large extent by legislation; this has, however, been offset by a restrictive population policy allowing only one child or two children per couple in some areas of the country (with no limit in Tibet), which has led millions of women to resort to prenatal sex diagnosis and abortion if the fetus is female. In the West, the debate over the use of biomedical technology continues, with various rabbinic rulings permitting the use of assisted reproductive technologies by Jews to fulfill the obligation to procreate, and the Vatican reinforcing its opposition to these and to genetic testing on embryos and embryonic stem cell research.     

Patho-epidemiology of Cancer Corpus Uteri in Karachi South '1995-1997'.

Aim: To provide demographics and pathology of cancer of the uterine corpus in Karachi. Methodology: Data for 66 incident cases of cancer corpus uteri, ICD-10 category C54-5 registered at the Karachi Cancer Registry, for Karachi South, during a 3 year period, 1st January, 1995 to 31st December 1997 were reviewed. Results: Cancer uterine corpus (1995-97) was the sixth most common malignancy, following breast, oral cavity, ovary, esophagus and cervix. The age standardized incidence rate (ASR) world and crude incidence rate (CIR) per 100,000 were 6.4 (4.73 to 8.01) and 2.9 (2.18 to 3.57). The mean age was 53.7 years (SD 15.6; range 6-90 years). Fifty eight cases were endometrial carcinoma with ASR world and CIR per 100,000 of 5.77 (4.20 to 7.33) and 2.53 (1.88 to 3.18) respectively. Sarcomas comprised 6% of the cases. Approximately a third of the females (28.8%) were below 50 years of age. The age-specific curves showed a gradual increase from the fourth till the seventh decade, followed by an actual apparent decrease in risk after 70 years. Peak incidence was observed in the 65-69 year age group. Presenting symptoms were post-menopausal bleeding (86.4%) and purulent discharge (4%). Associated pathologies included adenomyosis, adenomatous hyperplasia (12% each) or leiomyoma (8%). Associated clinical conditions were diabetes mellitus and hypertension (4% each). The majority of the cases presented as well differentiated (39.4%), localized (59.1%) lesions. Conclusion: The incidence of cancer corpus uteri in Karachi South reflects a moderate risk population, predominantly middle aged with a higher socio-economic status. On the average the malignancy is observed a decade earlier then reported elsewhere. This calls for in-depth investigation of risk factors and identification of underlying etiology.